The study relates outcomes and causes of death to events or risk factors measured in life among Pima Indian residents of the Gila River Indian Community, particularly in relation to diabetes and its complications, cardiovascular diseases and gallbladder disease. Causes of death and postmortem characteristics of Pima Indians of the Gila River Indian Community are investigated. Death certificates are obtained on all members of the Gila River Indian Community who have taken part in the ongoing longitudinal studies of diabetes and its complications. Postmortem examination results and all available medical records pertaining to the decedents are reviewed to ascertain conditions present at the time of death and ascertain the underlying and contributory causes of death as precisely as possible. The records are reviewed in a standardized way for evidence of the complications of diabetes, vascular disease, neoplasia and other conditions. The data are used to determine the causes of death and incidence of complications associated with diabetes and other characteristics identified during life by the longitudinal epidemiologic studies in the population. The increasing number of people receiving renal replacement therapy has resulted in many deaths being attributed to coronary heart disease that otherwise would have been attributed to diabetic nephropathy, thus explaining why coronary heart disease has become the leading cause of death in diabetic members of this community.